Does performance at the intercollegiate Membership of the Royal Colleges of Surgeons (MRCS) examination vary according to UK medical school and course type? A retrospective cohort study

Ricky Ellis, Peter A. Brennan, Duncan S.G. Scrimgeour, Amanda J. Lee, Jennifer Cleland

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Objectives The knowledge, skills and behaviours required of new UK medical graduates are the same but how these are achieved differs given medical schools vary in their mission, curricula and pedagogy. Medical school differences seem to influence performance on postgraduate assessments. To date, the relationship between medical schools, course types and performance at the Membership of the Royal Colleges of Surgeons examination (MRCS) has not been investigated. Understanding this relationship is vital to achieving alignment across undergraduate and postgraduate training, learning and assessment values. Design and participants A retrospective longitudinal cohort study of UK medical graduates who attempted MRCS Part A (n=9730) and MRCS Part B (n=4645) between 2007 and 2017, using individual-level linked sociodemographic and prior academic attainment data from the UK Medical Education Database. Methods We studied MRCS performance across all UK medical schools and examined relationships between potential predictors and MRCS performance using χ 2 analysis. Multivariate logistic regression models identified independent predictors of MRCS success at first attempt. Results MRCS pass rates differed significantly between individual medical schools (p<0.001) but not after adjusting for prior A-Level performance. Candidates from courses other than those described as problem-based learning (PBL) were 53% more likely to pass MRCS Part A (OR 1.53 (95% CI 1.25 to 1.87) and 54% more likely to pass Part B (OR 1.54 (1.05 to 2.25)) at first attempt after adjusting for prior academic performance. Attending a Standard-Entry 5-year medicine programme, having no prior degree and attending a Russell Group university were independent predictors of MRCS success in regression models (p<0.05). Conclusions There are significant differences in MRCS performance between medical schools. However, this variation is largely due to individual factors such as academic ability, rather than medical school factors. This study also highlights group level attainment differences that warrant further investigation to ensure equity within medical training.

Original languageEnglish
Article numbere054616
JournalBMJ Open
Issue number1
Early online dateJan 2022
Publication statusPublished - 5 Jan 2022

Bibliographical note

The authors would like to acknowledge Iain Targett at the Royal College of Surgeons of England, for his help with data collection and John Hines and Gregory Ayre from the Intercollegiate Committee for Basic Surgical Examinations for their support during this project. Our thanks to members of the UKMED Research Group who provided useful feedback on an earlier version of this manuscript, and whose comments helped refine the paper. The authors would also like to acknowledge Daniel Smith for his help with the UKMED database. Data source: UK Medical Education Database ('UKMED'). UKMEDP043 extract generated on 25/07/2018. We are grateful to UKMED for the use of these data. However, UKMED bears no responsibility for their analysis or interpretation the data includes information derived from that collected by the Higher Education Statistics Agency Limited ('HESA') and provided to the GMC ('HESA Data'). Source: HESA Student Records 2002/2003 to 2015/2016. Copyright Higher Education Statistics Agency Limited. The Higher Education Statistics Agency Limited makes no warranty as to the accuracy of the HESA Data, cannot accept responsibility for any inferences or conclusions derived by third parties from data or other Information supplied by it.

Data Availability Statement

Data may be obtained from a third party and are not publicly available. The dataset used in this study was acquired from the UK Medical Education Database and is held in Safe Haven. Data access requests must be made to UKMED. Full information for applications can be found at


  • adult surgery
  • medical education & training
  • surgery


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